COPD Exacerbation: Symptoms and Warning Signs

Written by Adrienne Santos-Longhurst
| Published on October 1, 2013Medically Reviewed by George Krucik, MD, MBA
on October 1, 2013

Patients with advancing COPD are susceptible to life-threatening complications stemming from respiratory viruses and bacteria. Learn the symptoms, warning signs, and available treatments for worsening COPD.

Even
though treatment of chronic obstructive pulmonary disease (COPD) can help to
slow the disease and minimize symptoms, there may be times when nothing seems
to be working and symptoms can get considerably worse. This is what is referred
to as COPD exacerbation and it has the potential to become life-threating if
not treated immediately.

According
to a paper published in AJN, American Journal of Nursing in February 2013,
exacerbations accelerate the deterioration of lung function. This is part of a
vicious cycle where as the disease advances the frequency of exacerbations
increases, in turn diminishing lung function. The article states that though
patients may recover lung function over the weeks following an episode, many
don’t recover to the same lung function as before the exacerbation.

Common Symptoms of Advancing COPD

As
previously stated, COPD often causes no symptoms or only mild ones until the
disease advances. In the beginning stages of COPD, the symptoms are so mild that
they go unnoticed, but as progression occurs, the symptoms begin to worsen.
Some of the more common symptoms of advancing COPD include:

ongoing cough

cough that is accompanied by excessive mucus
production, often referred to as a “smoker’s cough”

chest tightness

shortness of breath which is made worse with physical
activity

wheezing

The
severity of the symptoms of COPD depends on the amount of damage to the lungs.
As the damage worsens over time, the symptoms become more and more severe and
eventually can interfere with even the simplest day-to-day activities such as
walking or even just getting dressed. Smoking increases the speed at which the
damage occurs.

Along
with the common symptoms as listed, many of those with COPD will suffer from
frequent colds and flus. As the disease progresses it can cause other symptoms
as well, including:

breathlessness with physical exertion

swollen feet, ankles, or legs

weight loss

decreased muscle endurance

Exacerbation Triggers

Exacerbations
can be caused by anything that leads to inflammation in the lungs.
Understanding what the potential triggers are and making an effort to avoid
them can greatly reduce the amount of episodes and hospital visits.

Though
pollution and environmental irritants can trigger exacerbation, the majority
are caused by bacterial or viral infections. According to an article in the
American Family Physician in 2001, bacterial infection is a factor in
approximately 70 to 75 percent of COPD exacerbations with viruses being
responsible for the remaining 25 to 30 percent.

Other
causes of exacerbations in COPD are heart failure and not following the
prescribed treatment or maintenance therapy.

Signs and Symptoms of Exacerbation of COPD

COPD
exacerbation leads to an increased risk of severe and even life-threatening
complications. Being able to spot the
changes in symptoms in order to get proper medical care in a timely manner is
crucial. The following are signs and symptoms listed by the COPD Foundation that
could indicate an acute exacerbation which is a medical emergency that requires
immediate attention:

inability to catch breath or speak

confusion or excessive sleepiness

rapid heartbeat

blue or grey fingernails or lips

increase in mucus production

change in color of mucus to tan, yellow, green, or bloody

fever

inability to get relief of symptoms from your recommended
treatment

Exacerbation Treatment

Although
some cases of COPD exacerbation can be effectively treated at home, most
require treatment in a hospital.
Treatment may depend on the cause of the episode, such as the use of
antibiotics for bacterial infections.

Treatment
may also include one or more of the following:

bronchodilators

oxygen therapy

systemic glucocorticosteroids (oral or inhaler)

Due
to the increased risk of blood clots in the lung, patients are also often
administered prophylactic therapy for deep vein thrombosis as a precaution.

Management and Prevention

Along
with prescribed treatment there are several other things that one can do to
manage and even help to prevent exacerbations in COPD. The Mayo Clinic suggests
the following:

stop smoking

avoid air pollution

annual flu shot to reduce the risk of influenza-induced
episodes

pulmonary rehabilitation programs, which use a combination of
education, exercise, and nutrition counselling

Keeping
your regular appointments even when you’re feeling fine, washing your hands
regularly and avoiding large crowds during the cold and flu season also help to
prevent exacerbations in COPD.

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